Exsiccation prophylactic - prevention of a fluids deficit
Exsiccation is widespread among older patients.
- Each year 45,000 patients aged over 75 are diagnosed with an exsiccation in Germany alone.
- The inpatient treatment of these patients costs a total of 86,850,000 euros per annum.
- The average costs per patient are 1,930 euros.1
An early intervention can avoid life-threatening situations.
Why does an exsiccation occur?
Frequent causes and risk factors for an exsiccation are:
- Reduced feeling of thirst and a lack of appetite
- Stressful life events and depression
- Mental impairment
- Chewing and/or swallowing disorders, toothlessness
- Chronic diseases such as diabetes mellitus
- Forgetfulness and a restricted appreciation of problems
- Impaired motivation and restricted mobility
- Reduction of the amount of fluids by the patient in order to minimize the number of times the patient goes to the toilet or incontinence
- Lack of a prompt in an household environment that the patient should drink
- Pharmaceutic drug causes, multi-medication
- Increased perspiration
- Increased energy requirement
Recognise these risks and act at an early stage!
How do I recognise patients who are at risk?
There can be the following manifestations in patients who are at risk or who already suffer from an exsiccation:
- Worsening of the general condition even resulting in the patient being bedridden
- Reduced perceptibility
- Somnolence, lethargy and confusion
- Feeling of weakness and dizziness with the following consequences: inclination to fall, broken bones, immobility and decubitus
- Weight loss
- Reduced urine quantity, strongly concentrated urine
- Dry mucous membranes, lack of saliva underneath the tongue
- Drop in blood pressure, increase in the pulse frequency
- Thromboses, pulmonary embolism
- Electrolytes decompensation with convulsive seizures
- Upright skin fold (only in combination with other symptoms)
Watch out for these symptoms and intervene in good time!
How do I calculate the fluid requirements?
The patient´s weight is the basis for the calculations.
Calculation of the quantity of fluid that is to be administered2
100ml/kg body weight for the first 10kg
50ml/kg body weight for the next 10kg
15ml/kg body weight for each additional kg
- 2,040ml are indicated for a body weight of 56kg
- 2,190ml are indicated for a body weight of 66kg
- 2,325ml are indicated for a body weight of 75kg
0.33ml is calculated as pure fluid per calorie taken in and this is then deducted from the total requirement. Disease-related volume reductions such as with cardiac and renal insufficiencies for example, need to be individually taken into account, this also being the case with regard to an increased volume requirement in the event of volume losses, including with permanent suction, fever, emesis, fistulas/drainages and diarrhoea.
What do I have to do - tips for the practical application
- Infusion solution: 0.9% NaCl, Ringer´s lactate or a glucose solution
- Flow rates: depending on the patient, approx. 80–160ml/h
- Volumes: depending on the patient, approx. 500-2,000ml, normally max. 1,000ml per puncture site/day
- Puncture sites: abdomen, femur, lower back, between the shoulder blades
Subcutaneous hydration optimizes patient care.
- The implementation of the infusion can be delegated to trained non-medical staff.
- A physically and mentally burdening hospitalization can be avoided.
- A prevention of malnutrition includes an adequate administration of fluids.3
- The subcutaneous application has few complications.
Subcutaneous hydrations saves time and money.
- Reduction in hospital and patient transport costs.
- Reduced administrative expenditure in practices and nursing facilities.
- Reduced expenditure for the management of concomitant phenomena,
- e.g. when administering anticoagulants, surgical dressings, psychotropic drugs in order to alleviate symptoms.
- Reduced decubitus risk and lower expenditure for decubitus prophylactics.
- Avoidance of costs for treating possible consequential damages, e.g. caused by falls.
- Subcutaneous hydration aids do not affect the physician´s budget!
Subcutaneous hydration is easy to administer and is tolerated very well.
- For patients who are unable or unwilling to drink.
- For less cooperative patients.
- For difficult vein situations or intolerance of intravenous indwelling catheters – the subcutaneous form of application spares the veins.
- Can also be applied to mobile patients.
- Alternative procedures such as a PEG are contraindicated for patients who eat enough.
- A considerable improvement to the general condition can be achieved.
Fluids management is of high relevance when treating geriatric patients and it is also often difficult in daily nursing routine. The avoidance of exsiccation and their severe consequences necessitate fast action and optimized Solutions.
EZ Regular® gravity infusion regulator
Conventional feed systems can only be controlled with a difficulty. The precision drip regulator offers you:
- Precisely adjustable flow rates of max. 300ml/h
- Tube length of 240cm maximises the freedom of movement
BodyGuard 323 mobile infusion pump
In the even of oedemas forming, fluids need to be administered with infusion rates of just a few ml/h, this not being possible via gravity. The mobile infusion pump provides for a:
- High degree of mobility
- Secured infusion irrespective of the position
How are patients with a risk of exsiccation currently cared for by you and what do you want to optimize?
We would be pleased to advise you on the possibilities and benefits provided by subcutaneous hydration.
T +49 2236 9641-70
1) Data according to § 21 KHEntgG 2008 grouped for 2009, as well as DRG-Abschlussbericht 2009
2) DGE et. al., Reference date for nutrient supply, 2000
3) Expert knowledge nutrition management of the Deutschen Gesellschaft für Ernährungsmedizin (DGEM) developed based on § 113a SGB X1